Oneplan medical insurance is a no go!!!!

Oneplan medical insurance is a nightmare!!! STAY AWAY!!!

To give context to the problem we have with Oneplan now I have to start at a serious life threatening situation happened to my mom August 2024, I was so shocked by how Oneplan treated my mothers situation where I ended up cancelling my own plan with them.

August 2024 my mother was admitted to hospital and after doing a CT scan they have discovered that my mom has bleeding in her brain. She was rushed from Cormed Hospital to Busamed in Modderfontein to get urgent treatment.

After being transferred and more scans being done like an MRI the Doctors and Professor said my mom needed urgent treatment because she has an aneurysm in her brain that started leaking and should it burst my mother could die.

You would think this is enough for Oneplan to authorise Dreaded disease cover because aneurysm is one of the dreaded diseases they cover... Well no!! The doctors had to first write an report after they have done the MRI to motivate how serious my mom's condition is so that dreaded disease cover can kick in because there was not enough funds available for them to do the procedure on the normal hospitalisation due to illness.

After a whole day goes by , going back and forth with Oneplan,FINALLY with the help of the doctors authorisation comes through and they can do the angiogram to coil the aneurysm.

From the month of August up to the 29th of November I had to fight with Oneplan to get claims paid. Oneplan covers up to R335 000 for dreaded disease but to get them to pay the claims up to that amount is a struggle. You can call, email and WhatsApp them all you like they just don't get the issues resolved. You get passed on from one agent to another, you cannot speak to a manager that request also gets declined. We even lodged a complaint with their complaints department because of the frustration.

On the 14th of January 2025 my mom felt very ill and was taken to Netcare Alberton. Oneplan does have cover for casualty so we take her there to see what is going on. Triage marks my mom as a level orange because of her symptoms but when the hospital phones Oneplan for authorisation they declined and specifically told my mom that they won't pay for anything if it is related to her aneurysm because the maximum amount has been paid out for the dreaded disease but if it something else they will pay. We accepted that and decided to pay for the casualty ourselves.

The Dr at Netcare causalty sends my mother for an MRI which we also paid for ourselves and after that the Dr advised that the MRI looks good and it is not the aneurysm, but wants to admit my mom into the hospital for meningitis.

Oneplan comes back and says no, meningitis cannot be covered because it has to do with her aneurysm claim which I don't even know how they got to that conclusion because their own policy disclaimer and terms and conditions of what an aneurysm is, is no where close to what meningitis is. We are on the phone with them back and forth and they said they need lumbar puncture results indicating my mom has meningitis before they will give authorisation.

We don't have the R54 000 Netcare requested to admit my mother to hospital so we left the casualty department and my mother goes home but she told the Dr at Netcare she will go to Cormed Hospital in the morning. She left the hospital still feeling very ill.

On the 15th of January 2025 my mom goes to Cormed hospital casualty department explained everything from the previous day and the Doctor decided my mom needs to do the lumbar puncture and additionally she also has to go for a CT scan. The CT scan comes back clean indicating it is not related to the aneurysm and the Dr at Cormed also said my mom needs to start with treatment for meningitis because some results of the lumbar puncture takes up to 7 days and we cannot wait that long before she starts getting the treatment. To my understanding meningitis can be fatal if not treated in time.

The Dr again writes a report to Oneplan and again they decline authorisation for hospitalisation due to illness because they first want the lumbar puncture results.

We have done every possible test to make sure it is not the aneurysm but that is nog good enough for Oneplan. How does Oneplan expect us to wait 7 days ????? Not one but two doctors are of the opinion that my mom needs to get treatment for meningitis but Oneplan knows better? They would rather let you die before getting you admitted to a hospital.Oneplan’s has declined both motivations by the Dr’s who evaluated my mom in person and are in my opinion questioning the capabilities of their work and findings.

We have now paid out of our pocket over R40 000 just to get the test done and my mom admitted to hospital and start the treatment for meningitis.

The Insured can only claim again for a new event for the same disease after a six month "resting" period from the end of the previous incident - We don't want to claim for the same disease.

As per one of their conditions mentioned that they cover under dreaded disease:*"Surgery to Aorta / aneurysm" An aneurysm is a bulge or "ballooning" in the wall of an artery. Arteries are blood vessels that carry oxygen-rich blood from the heart to other parts of the body. If an aneurysm grows large, it can burst and cause dangerous bleeding or even death. Dread Disease cover will be considered when surgery is required to repair or correct an aneurysm, narrowing, obstruction or dissection of the aorta through surgical opening of the chest or abdomen, excluding surgery of the branches of the thoracic and abdominal aorta.”*

*”SPECIAL CONDITIONS (READ THIS BIT CAREFULLY): 1. A six (6) month "resting" period after an event twelve (12) months is applicable. This means you can only claim again for a new event for the same disease after a six (6) month "resting" period from the end of the previous 2. In the lifetime of a policy each dependant on your policy will only be allowed to claim up to three (3) times for the same dread disease.”*

An Aneurysm and Meningitis is not the same disease as they are claiming that meningitis forms part of the aneurysm claim and that both conditions are brain related therefore it falls under the dreaded disease claim which has been depleted. Yet they cover 3 dreaded diseases that are brain related. There has been no evidence that meningitis is linked to the Aneurysm. Nowhere on their T&C’s that if you have had treatment for an aneurysm that you can not get treated for something else related to the brain for Illness in Hospital.

I am beyond disappointed with Oneplan!!!!!!!!